This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Thursday, June 19, 2014

Review Of The Ongoing Post - Budget Controversy 19th June 2014. It Is Sure Going On and On!

Budget Night was on Tuesday 13th May, 2014 and the fuss has not settled by a long shot.

Here are some of the more interesting articles I have spotted this fifth week since it happened. Since the budget was handed down all hell has broken out in the Health Sector and has been continuing.

We have both the Senate and the House of Representatives sitting in the 2 weeks starting 16th June - so it will be very interesting to see just what the debate on specific health measures looks like.

We sure do live in interesting times!

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General.

The Sydney Morning Herald's Economics Editor

Coalition governments have been banging on about the need for ''smaller government'' since Malcolm Fraser started echoing Maggie Thatcher and Ronald Reagan. They've talked without doing anything. Until now.

Few have noticed, but the goal of this budget is to reduce government spending by 1.1 per cent of gross domestic product (GDP), from 25.3 per cent this financial year to 24.2 per cent in 2024-25.

If that doesn't impress you, this may: Joe Hockey's plan is to cut government spending to 0.7 percentage points below its 30-year average of 24.9 per cent.

That makes this the most ideologically driven budget we've seen - not that Hockey or Tony Abbott will admit it. They claim the budget's harsh measures are needed simply to get the budget back to surplus and start paying down the public debt.

Kim Oates

Better doctor-patient communication, as per the Open Notes project, could save billions of dollars and improve health in Australia.

Let’s have a more visionary approach to reducing health costs. While most see the need to reduce health costs, wouldn’t it be refreshing if our politicians and their advisers looked at more visionary ways of cost reduction instead of a $7 co-payment, a scheme which will become a cost-shifting exercise as patients reluctant or unable to pay this amount will just turn up at already overburdened emergency departments?

While it’s true that health costs are rising as the population ages, we aren’t all that different from other developed countries. At 9.5 per cent of GDP our health expenditure is a little above the OECD average of 9.3 per cent and well below the US at 17.9 per cent, the only OECD country without universal health coverage and with a strong focus on privatisation.

Tom Delbanco, a Harvard professor, has helped to reduce costs. He had the audacity to suggest patients have access to their medical notes. His colleagues were aghast, saying this would be time consuming for doctors and cause anxiety in patients. Delbanco persisted.

A national institution, Medicare turns 40 this year. But are budgetary changes such as the doctor co-payment the beginning of the end for universal healthcare? Michael Green reports.

Medicare was always a dogfight. It became law in the most extraordinary circumstances: one of a handful of bills passed during the only joint sitting of Federal Parliament in the nation's history, after the double dissolution election in 1974.

As the Whitlam government prepared to introduce the system - then known as Medibank - its opponents rallied. The Australian Medical Association marshalled a million-dollar ''Freedom Fund'', donated by members. Determined to stop bureaucrats interfering with patients, it hired a former Miss Australia to front its publicity campaign. The General Practitioners' Society of Australia circulated a poster depicting social security minister Bill Hayden dressed in Nazi uniform.

Dr Anne-marie Boxall, co-author of Making Medicare, says Whitlam had little support, even from within the Labor Party. The party platform advocated a fully nationalised model, along the lines of the British National Health System. By contrast, Whitlam's plan was for a public insurance scheme. Health services would be delivered by a mix of public and private providers, paid for by taxpayers and guaranteed for everyone.

Health Editor, Sydney Morning Herald

Hospitals and police will be left bearing the brunt of a $5 million cut to inner-city homelessness services and the safety of vulnerable people put at risk, health experts say.

The Australian Medical Association NSW fears the decision, combined with cuts to federal homelessness funding and mooted GP co-payments, poses a threat to the health of the homeless community.

St Vincent's Hospital in the inner city is already seeing patients evicted from refuges that are closing under a new government policy, called ''Going Home, Staying Home'', which is shifting resources from the city to the suburbs.

The Sydney Morning Herald's Economics Editor

Tony Abbott has turned out to be a chameleon. Before the election, he took the guise of a populist, opposed to all things nasty and in favour of all things nice. Since the election, he's revealed himself to be a hard-line ideologue, intent on reshaping government to suit the interests of big business and high-income earners.

Before the election, he was the consummate vote-seeking politician. Since the election, he has transformed into an inflexible "conviction politician" who doesn't seem much worried about whom he offends.

Dr Mike Keating, former top econocrat, says the budget is always the clearest guide to a government's priorities and values. That's certainly true this time.

This budget scores high marks for its efforts to get the budget back on track. As almost every economist will tell you, there is no "budget emergency". But there would be problems if we allowed the budget to stay in deficit for another 10 years, which was a prospect had Abbott failed to take tough measures (all of which were in marked contrast to his sweetness and light before the election and many of which were in direct contradiction to his promises).

Health and Indigenous Affairs Correspondent

The Red Cross will have to find $5 million in savings after the Abbott government ceased an annual grant to the organisation.

The former Howard government started paying a $5 million grant to the Red Cross in 2006 and the Rudd and Gillard governments continued the grant. But Health Minister Peter Dutton has notified the Red Cross that the government would not pay the grant from this year.

In a email to staff, volunteers and members, Australian Red Cross chief executive Robert Tickner wrote that the news was "especially hurtful" as the organisation prepared to celebrate its centenary "after 100 years of service to the people of Australia".

"This will inevitably have a significant, but limited, impact on services, programs and support functions and on staff and volunteers in specific areas," wrote Mr Tickner, who was a minister for indigenous affairs in the Hawke and Keating Labor governments.

The budget, it's been argued, is heavy-handed, unjust and illogical. Most Australians don't want the budget to pass in its current form. Nor do a number of elected representatives, including several Liberal MPs.

But so far it's primarily been opposition parties making their case about how they plan to block the budget. Is there anything that we, as citizens, can do to block the budget in our own right?

Yesterday was a sorry day in the long history of health reform in Australia. The Council of Australian Governments (COAG) Reform Council issued its five year score-keeper’s report on health reform progress. It will be the last such report, since the COAG Reform Council has been sacrificed on the altar of savings in the May budget, and we will no longer know how our governments are performing.

The COAG Reform Council paints some lipstick on the pig but overall reform results are poor in the health system. Compared to last year, Australians are waiting marginally longer for elective surgery, longer for community support in the home, and dramatically longer to get into residential aged care.

Australian Medical Association president Dr Brian Owler says if a woman with a breast lump delays a scan because of the cost and the lump turns out to be malignant “that could be the difference between life and death”.

AUSTRALIANS are still waiting too long for elective surgery despite Labor’s much-vaunted health reforms, the COAG Reform Council has warned.

In its five-year review of the health system, the council has highlighted how median waiting times rose for 14 out of 15 selected surgical procedures during that period, driven largely by significant increases in NSW, despite the former government’s promise to improve outcomes.

It also noted with concern the rise in potentially preventable hospitalisation rates for vaccine-preventable and acute conditions, and the rise in obesity and diabetes, which will add pressure on the health system in future.

The Abbott government has torn up Labor’s agreement for the federal government to provide a greater proportion of public hospital funding from 2017-18, and also scrapped the national partnership agreement on improving public hospital services due to the states’ poor performance. Preventive health funding has also been slashed.

The Health Minister says there's been a 42% growth in Medicare spending over the past five years. Is he right?

Peter Dutton's claim: “[On] the sustainability of Medicare... there’s been 42% growth over the last five years alone.”

HEALTH
spending must be reined in before it overwhelms the federal budget.
That’s the core argument for the government’s health platform, including
its embattled $7 Medicare co-payment.

Health Minister Peter Dutton told ABC Newson 23 May: “[On] the sustainability of Medicare... there’s been 42% growth over the last five years alone.”

That
sounds alarming. And health department Medicare data supports the
figure. From the 2007–08 financial year to 2012–13, spending went up to
$18.6 billion from $13 billion. Using more recent calendar year data,
the increase is lower – at 36%.

But those numbers leave out much of the story, experts say.

Health
economist Dr Stephen Duckett from the Grattan Institute said Medicare
spending was rising, but Mr Dutton had cherry-picked the highest
possible figure.------

Health and Indigenous Affairs Correspondent

CSIRO chairman and former Australian of the Year Simon McKeon says it would be a ''tragedy'' if opposition to the proposed $7 Medicare co-payment prevented the creation of a $20 billion medical research fund.

The Abbott government is proposing a medicare research fund to be funded by a range of health savings, including the $7 Medicare charge, a $5 increase in patient payments for pharmaceuticals, and reductions in public hospital funding.

But with Labor, the Greens and the Palmer United Party fiercely opposed to the $7 fee, the proposal appears unlikely to pass Parliament.

Addressing the National Press Club in Canberra on Wednesday, Mr McKeon, who also chaired a strategic review of health and medical research for the Gillard government, backed the assessment of Health Minister Peter Dutton that change was necessary to control growth in health spending.

GP Co-payment.

Health and Indigenous Affairs Correspondent

The federal government has been accused of operating in an ''evidence-free zone'' by introducing a $7 fee for Medicare services in the absence of data about how many people are bulk-billed.

The Department of Human Services, which owns Medicare data, last week refused a freedom-of-information request from the Australian Healthcare and Hospitals Association for data on the number of people who are bulk-billed, on the grounds the information does not exist.

The refusal came after Health Department officials told a Senate estimates hearing last week it had not modelled the impact of the $7 charge on hospital emergency departments and follows National Commission of Audit chairman Tony Shepherd conflating visits to the doctor with Medicare items.

In a letter refusing the association's information request, the Department of Human Services said while it could be possible for it to produce such data, this would require computer programming, which would constitute ''a substantial and unreasonable diversion of the department's resources''.

THE architect of the government's controversial co-payment plan has backed a thwarted Freedom of Information (FOI) request to release more detailed Medicare data into the public domain.

Speaking to MO, Tony Abbott's former advisor Terry Barnes said his co-payment model, and criticisms of it, are based on "educated guesswork" until the information is released.

The request was made by the Australian Health and Hospitals Association (AHHA) to the Department of Human Services and asked for detailed data on the number of people who are bulk-billed, as distinct from the number of services that are bulk-billed. It was knocked back on two grounds.

The first was that no document existed which contains the information, and the second was that to produce it would require a "substantial and unreasonable diversion of the department's resources", and the "development of specific coding".

The Abbott government is weathering a storm of opposition to its proposed budget items that would see the introduction of co-payments for GP consultations, pathology and radiology test orders, and pharmaceutical prescriptions. Even the most centrist of commentators are expressing concerns that the risk of unintended consequences of these measures are a real and present danger to the health of Australians.

Co-payments might add revenue and demand, and hence Medicare expenditure, in the short term at best. However, had the proposal been submitted as an assignment by a student of macro accounting, it might scrape in a pass grade. It represents a fail, however, of sound health economic policy, for it is too blunt a tool to reduce with scalpel precision those supposed “unnecessary” GP visits, tests and medicines.

Instead, we know from international evidence that necessary care will drop, and with it will go opportunities for ­prevention and low-cost disease management. That other advanced economies, with high performing efficient health care systems, are moving in the opposite direction and strengthening the foundations of access to primary health care should be strong cause for modest, impartial reflection.

ANALYSTS expect the business environment for GPs will be increasingly fragmented and competitive in the brave new world of the co-payment.

With the AMA now working out its preferred co-pay model as an alternative to the government’s proposed $7 slug for GP visits and medical services, the end of free Medicare for most Australians seems all but assured.

Analysts at investment bank UBS speculate that in a scenario where a co-payment is part of the landscape, GPs will move to distinguish themselves in terms of price and could charge what the market will bear.

“Where a GP has a concession/non-concession patient mix
of 50:50, it is untenable to not charge the $7 co-pay,” a UBS report says.

THE final COAG Reform Council report on healthcare shows the cost of seeing a GP is not currently a barrier for most people, but the AMA and Opposition argue this will change if the co-payment is implemented.

During 2012–13 just 5.8% of people delayed or did not see a GP due to cost and 8.5% did not fill a prescription for the same reason.

But those figures balloon to one in eight and one in three for Indigenous Australians aged 15 years or older, and the Indigenous child death rate remains twice as high as the non-Indigenous rate.

One in four Australians reported waiting more than 24 hours to see a GP for an urgent appointment, while two in three reported access in under four hours.

Liz Marles, the president of the Royal Australian College of General Practitioners, said in areas like western and south-western Sydney where doctors are solo and older than average, the change encourages them to opt out.

“Given 41 per cent of GPs in urban areas are over 55 anyway, these guys are probably more like 60-plus, and so they, I think that if you squeeze them. . . or require them to go through a lot of change in order for them to be able to continue to provide a service then they’ll just choose retirement,” she said.

“We don’t want to see people pushed into retirement, and we believe that the doctor-patient relationship is critical to good outcomes,” Ms Marles said. “I think it will probably lead to increased corporate medicine in those areas.”

A five-point plan to rescue the Federal Government's maligned co-payment plan has been drawn up by the man who inspired the policy.

Terry Barnes (pictured), the former health advisor to Tony Abbott, said the proposals — which cut nearly $2 billion in Medicare rebates for patients to see their GP and may result in significant cash losses for doctors who bulk-bill vulnerable patients — were doomed.

But he suggested recently in the Australian Financial Review there was a "fairer and less regressive" co-payment option for general practice, with five key points.

Health Reporter

NSW stands to lose almost $200 million in health funding due to federal cuts, a shortfall the Australian Medical Association warns will be detrimental to emergency departments already struggling to cope with demand.

AMA NSW head Saxon Smith has called for at least 9 per cent - or $1.4 billion - increase in funding in next week's state budget in order to ''keep the NSW health system going''. ''Anything less than that will cause a standstill,'' Dr Smith said.

''We need $191 million to fill the gap left by federal cuts and 7 per cent growth to cover inflation and patient demand. Without it there will be a massive strain on the health system and a bottleneck in emergency departments.''

He said NSW had been the hardest hit by the federal budget, with the government pulling out of national partnership agreements that funded sub-acute beds for rehabilitation, mental health and aged care, and scrapping reward payments for meeting emergency department and elective surgery targets.

Canberra Times reporter

The federal government looks set to hand over financial data to the ACT in a bid to quell a disagreement over whether health funding is facing cuts under the budget.

Federal Health Minister Peter Dutton made the commitment during a meeting in Sydney with state and territory health ministers after ACT Chief Minister Katy Gallagher raised concerns about funding for the territory's health system.

The ACT government estimates federal budget cuts will rip about $240 million from the territory's health system over the next four years. But the federal government disagrees, with Mr Dutton saying budget papers show funding for ACT hospitals would increase from $272 million in 2013-14 to $328 million by 2016-17.

Ms Gallagher said it was pleasing that Mr Dutton had agreed to share the federal financial data.

WA pharmacists are moving to vaccinate customers under a plan the top doctors group warns would have people immunised next to “jelly beans and sanitary pads”.

The Pharmacy Guild of WA has asked Curtin University to make vaccination training part of its undergraduate pharmacy course.

It follows the start of a two-year pharmacy immunisation trial in Queensland and comes amid a national turf war over who should be able to administer the jabs.

Pharmacy Guild of WA branch committee member Paul Rees said the body had held early discussions with the university about launching an accredited training program.

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Comment:

It seems the fuss is not yet settled - to say the least. Will be fascinating to see how all this plays out. Parliament this and next week will be very interesting indeed! It is clear the GP co-payment issue is red-hot and right now it is hard to see how this measure will pass.

To remind readers there is also a great deal of useful health discussion here from The Conversation.